Bronchoscopic thermoplasty

BRONCHOSCOPIC THERMOPLASTY

Dr:MUHAMMED .W. AL,OBAIDYCHEST PHYSCIAN

MEDICAL COLLEGEBAGHDAD UNIVERSITY

Role of Airway Smooth Muscle (ASM) There is typically an increase in the amount of

airway smooth muscle in the lungs of patients with asthma.

This increased airway smooth muscle mass has the potential to increase airway responsiveness and constriction in response to external stimuli, such as dust, allergens, cold air or stress.

The excessive and inappropriate constriction of airway smooth muscle is recognized as a predominant feature of asthma, and therefore makes the airway smooth muscle a key target for drug therapy

Role of Airway Smooth Muscle (ASM)Although current medications are reasonably

successful in controlling inflammation and contraction of airway smooth muscle in the majority of patients with asthma.

some patients with severe persistent asthma continue to suffer from excessive bronchoconstriction that is integral to an asthma “attack” (exacerbation).

Reduction of airway smooth muscle helps reduce the ability of the airways to narrow in response to a trigger, thereby providing a therapeutic benefit for patients with severe asthma.

The ProcedureBronchial thermoplasty is delivered by the

Alair® System and is performed in three outpatient procedure visits, each scheduled approximately three weeks apart. The first procedure treats the airways of the right lower lobe, the second treats the airways of the left lower lobe and the third and final procedure treats the airways in both upper lobes. After all three procedures are performed the bronchial thermoplasty treatment is complete.

The ProcedureThe patients prepped and placed under

moderate sedation.“conscious sedation”. A standard flexible bronchoscope is

introduced into the bronchial tree through either nose or the mouth, and the Alair® Catheter is introduced into airways through the bronchoscope.

The ProcedureThe bronchoscope is then navigated to the

first target treatment site, typically the most distal airway in the targeted lobe.

BT is delivered by the Alair® System, which is comprised of an Alair® Catheter and an Alair® Controller.

The ProcedureOnce the Alair® Catheter is positioned at the desired

location of airway, the electrode array at the tip of the Alair® Catheter is expanded to contact airway wall; the physician activates the Alair® Radiofrequency (RF) Controller to deliver RF energy through the Alair® Catheter to airway wall.

The Alair® RF Controller delivers low-power, temperature-controlled RF energy to the airway for a maximum of 10 seconds per activation. The RF energy heats the wall of a portion of airways in a controlled manner.

The application of heat to the airway wall is intended to reduce the amount of excessive airway smooth muscle present in the airways and limit its ability to contract and narrow the airway.

The ProcedureA single activation of the Alair® Catheter delivers RF

energy over a distance of 5 mm (the length of the exposed electrodes within the electrode array). Audible and visual cues from the Alair® RF Controller signify proper delivery of RF energy.

After each activation the Alair® Catheter is repositioned and subsequent activations are performed contiguously (adjacent but not overlapping) along airway. This technique is used in all of accessible airways distal to the mainstem bronchi and ≥ 3 mm in diameter. The Alair® Catheter is deployed from the distal to the proximal end of airway being treated. This process is repeated in all of airways that are accessible and planned for that bronchoscopy session.

The ProcedureBT is delivered by the Alair® System, which is

comprised of an Alair® Catheter and an Alair® Controller.

Once the Alair® Catheter is positioned at the desired location of airway, the electrode array at the tip of the Alair® Catheter is expanded to contact airway wall; the physician activates the Alair® Radiofrequency (RF) Controller to deliver RF energy through the Alair® Catheter to airway wall.

The Alair SystemAlair® Catheter

The Alair® Catheter is a single-use device designed to be delivered through the working channel of a standard bronchoscope.

Expandable electrode array with four 5 mm electrodes that deliver RF energy to airways ≥ 3 mm in diameter and distal to main stem bronchi

Requires ≥ 2.0 mm working channel diameter standard high-frequency compatible flexible bronchoscope

The Alair System

Designed with proprietary control parameters and algorithms to deliver the correct intensity and duration of thermal energy sufficient to reduce excess ASM, while limiting long-term impact to surrounding tissues

(Indication for Use)

treatment of severe persistent asthma in patients 18 years and older.

whose asthma is not well controlled with inhaled corticosteroids and long acting beta agonists.

(Contraindications)

• An implant with electronic such as a pacemaker. BT may keep the implant from working correctly.

• Problems taking certain medicines. needs to make sure the medicine he or

she uses will not hurt you.

(Contraindications ) Have had this treatment before.

• You cannot have this treatment if you are less than 18 years old. No one has tested BT in patients younger than 18 y

 • An active respiratory infection.

(Contraindications ) • Have had an asthma attack or changed

oral corticosteroid dose in the last 2 weeks.

BT may harmfull. • A blood clotting problem.

Preparation of patientsYou will prepare for each treatment by

taking a 50-mg steroid pill by mouth once a day for 3 days before the treatment.

• You will also take a 50-mg steroid pill on the day of the treatment.

• On each BT treatment day, pulmonary function test must be done.

What are the benefits of bronchial thermoplasty32% reduction in asthma attacks84% reduction in emergency room visits for

respiratory symptoms66% reduction in days lost from work, school, or

other daily activities due to asthma symptoms73% reduction in hospitalizations for respiratory

symptomsThese benefits were observed during clinical studies

where patients continued to take their standard maintenance asthma medications which included combinations of inhaled corticosteroids and long-acting bronchodilators

Are there any post-procedure complications?

Adverse events (whether considered procedure-related or not procedure-related by the investigator) occurring with ≥ 3% incidence that were more common in the Alair® group are presented for 288 patients in

Table 1

Procedure AvailabilityThe Alair® Bronchial Thermoplasty System

was approved in April 2010 by the Food & Drug Administration (FDA) for the treatment of severe asthma in adults.

THANK YOU